Family-Based Interoceptive Exposure for Avoidant Restrictive Food Intake Disorder

基于家庭的内感受暴露治疗回避型限制性食物摄入障碍

• 批准号: 10728623
• 负责人: Robyn Jennifer Sysko
• 金额: $ 25.35万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-22 至 2026-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10728623
• 关键词: Adherence; Adolescent; Adverse event; Affect; Age; Anorexia Nervosa; Awareness; Behavior Therapy; Characteristics; Child; Choking; Clinical; Clinical Trials; Complementary Health; Consumption; Cues; Data; Data Collection; Diagnosis; Distress; Dose; Dropout; Eating; Eating Disorders; Emotions; Extinction; Family; Food; Food Aversion; Food Hypersensitivity; Food Patterns; Fright; Growth; Health; Incentives; Individual; Integrative Medicine; Intervention; Learning; Longevity; Malnutrition; Medical; Mind-Body Intervention; Modeling; National Center for Complementary and Integrative Health; National Institute of Mental Health; Outcome; Patient Care; Patients; Physiological; Population; Procedures; Property; Recording of previous events; Reflex action; Reporting; Rewards; Secondary to; Sensory; Signal Transduction; Site; Standardization; Symptoms; Testing; Vomiting; Weight; Well in self; Youth; acceptability and feasibility; active comparator; aged; approach behavior; associated symptom; avoidance behavior; avoidant restrictive food intake disorder; comorbidity; early childhood; efficacy trial; experience; family support; feeding; food avoidance; functional disability; gastrointestinal symptom; improved; innovation; interest; male; mind/body; mindfulness; neural circuit; patient tolerability; psychologic; recruit; response; restoration; sex; skills; stem; success

Project Summary/Abstract Avoidant/restrictive food intake disorder is commonly associated with severe nutritional deficiencies, low weight/growth for age and sex, and significant distress, and can cause serious psychological and medical sequelae and functional impairment across the lifespan. The core feature of ARFID is a pervasive pattern of food avoidance, related to a lack of interest in eating or food, sensory characteristics of food, or concern about the aversive consequences of eating. Studies examining interventions for ARFID are limited, and additional options for intervention are needed. Mind-body interventions are well-matched to individuals with ARFID because of their physiologically driven aversion to food-cues, with interoceptive experiences overwhelming the rewarding (natural reinforcing) properties of food and reduce approach behavior. Our group recently developed and tested a brief 6-session mindfulness-based interoceptive exposure intervention for families of patients with anorexia nervosa and related conditions. The intervention focused on families supporting adolescents to reach a threshold of increased tolerance of the aversive emotion of disgust and greater engagement in approach behavior during feeding. Although food avoidance is a shared feature across conditions, adolescents with ARFID and those with other eating disorders are distinct populations. Our success with this prior mechanistic study provides a framework for the use of interoceptive exposure. Given differences in the clinical presentations, this project will establish essential information about the feasibility and acceptability of a comprehensive mind and body family intervention for youth with ARFID; specifically a mindfulness-based interoceptive exposure (MBIE) for the high priority outcomes of health restoration and emotional well-being. A total of 57 adolescents with ARFID (aged 12-18) will be recruited to receive MBIE in an innovative dose-optimization approach to assess when a clinically-meaningful outcome is achieved, and assess tolerability and treatment characteristics, with the aim to distilling the most potent form of MBIE in 40 completers. We will: (1) explore the feasibility of recruitment, retention, and data collection procedures with youth with ARFID at end of treatment, (2) establish the acceptability and adherence of the MBIE intervention, and (3) evaluate the number of MBIE sessions required to observe changes in the number of foods avoided and mindfulness skills. These data can help to inform the utility of larger more definitive studies that have the potential to make a significant impact on the health and functioning of adolescents with ARFID.

项目概要/摘要 回避/限制性食物摄入障碍通常与严重营养缺乏、体重/年龄和性别生长低以及显着的痛苦有关，并可能导致严重的心理和医疗后遗症以及整个生命周期的功能障碍。 ARFID 的核心特征是一种普遍的食物回避模式，与对饮食或食物缺乏兴趣、食物的感官特征或对饮食厌恶后果的担忧有关。检验 ARFID 干预措施的研究有限，需要额外的干预方案。身心干预与 ARFID 患者非常匹配，因为他们对食物线索有生理驱动的厌恶，内感受体验压倒了食物的奖励（自然强化）特性并减少了接近行为。我们的小组最近为神经性厌食症及相关疾病患者的家庭开发并测试了一种为期 6 次的基于正念的简短内感受暴露干预措施。干预措施的重点是家庭支持青少年达到增加对厌恶厌恶情绪的容忍度的阈值，并在喂养过程中更多地参与接近行为。尽管回避食物是各种情况的共同特征，但患有 ARFID 的青少年和患有其他饮食失调的青少年是不同的人群。我们之前的机制研究的成功为内感受暴露的使用提供了一个框架。鉴于临床表现的差异，该项目将建立关于对患有 ARFID 的青少年进行全面身心家庭干预的可行性和可接受性的重要信息；特别是基于正念的内感受暴露（MBIE），以实现健康恢复和情绪健康的高度优先结果。将招募总共 57 名患有 ARFID 的青少年（12-18 岁），以创新的剂量优化方法接受 MBIE，以评估何时实现具有临床意义的结果，并评估耐受性和治疗特征，目的是提炼出MBIE 对 40 名完成者最有效的形式。我们将：(1) 探索治疗结束时对患有 ARFID 的青少年进行招募、保留和数据收集程序的可行性，(2) 建立 MBIE 干预措施的可接受性和依从性，以及 (3) 评估 MBIE 课程的数量需要观察避免的食物数量和正念技能的变化。这些数据有助于为更大规模、更明确的研究提供信息，这些研究有可能对患有 ARFID 的青少年的健康和功能产生重大影响。